Management of Early Post-Transplant Hyperglycemia by Dedicated Endocrine Care Improves Glycemic Outcomes.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL Clinics and Practice Pub Date : 2024-09-25 DOI:10.3390/clinpract14050156
Alon Kaplan, Tslil Manela, Tammy Hod, Ronen Ghinea, Eytan Mor, Amit Tirosh, Amir Tirosh, Gadi Shlomai
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Abstract

Introduction: Early post-transplant hyperglycemia (EPTH) is an independent risk factor for hospital readmissions, acute rejection, infections and developing post-transplant diabetes mellitus (PTDM). Close glycemic control is prudent in the early post-transplant period. The management of EPTH was evaluated among a cohort of kidney transplant recipients, who either received routine care (RC) or dedicated endocrine care (DEC).

Methods: A retrospective analysis was conducted on kidney transplant recipients from 2019 to 2023. The impact of DEC on post-transplant glycemic control was investigated. Hospitalized patients receiving post-transplant insulin therapy were included. DEC involved at least twice-daily blood glucose (BG) assessment by an endocrinologist, while the RC received usual care. A mixed-model analysis was employed to assess differences in BG trajectories between DEC and RC over an eight-day period. Additionally, various glycemic control metrics were compared, including glucose variability, time-in-range for target BG, rates of hypoglycemia and response to hyperglycemia.

Results: The cohort comprised 113 patients. In the DEC group, 91% had pre-transplant DM compared to 15% in the RC group (p < 0.001). Patients under DEC had higher baseline BG and glycated hemoglobin compared to those under RC (p < 0.001, for both). The DEC group displayed a lower trajectory of BG over time compared to the RC group (p = 0.002). Patients under DEC were more likely to receive insulin if BG measured above 200 mg/dL (66% vs. 46%) and displayed less below-range BG (<110 mg/dL) compared to those under RC (12.9% vs. 23.6%, p < 0.001).

Conclusions: Management of EPTH by DEC improves glycemic outcomes in renal transplant recipients.

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由专职内分泌护理人员处理移植后早期高血糖可改善血糖结果。
导言:移植后早期高血糖(EPTH)是导致再住院、急性排斥反应、感染和发生移植后糖尿病(PTDM)的独立风险因素。在移植后的早期,密切控制血糖是非常谨慎的做法。我们对一组接受常规护理(RC)或专门内分泌护理(DEC)的肾移植受者的 EPTH 管理情况进行了评估:对2019年至2023年的肾移植受者进行了回顾性分析。调查了 DEC 对移植后血糖控制的影响。纳入了接受移植后胰岛素治疗的住院患者。DEC包括由内分泌专家进行至少两次的每日血糖(BG)评估,而RC则接受常规护理。采用混合模型分析评估了 DEC 和 RC 在八天内的血糖轨迹差异。此外,还比较了各种血糖控制指标,包括血糖变异性、目标血糖范围内时间、低血糖发生率和对高血糖的反应:研究组共有 113 名患者。在DEC组中,91%的患者在移植前患有糖尿病,而在RC组中只有15%(P < 0.001)。接受 DEC 治疗的患者的基线血糖和糖化血红蛋白高于接受 RC 治疗的患者(两者均为 p <0.001)。随着时间的推移,DEC 组的血糖轨迹低于 RC 组(p = 0.002)。如果血糖测量值高于 200 mg/dL,DEC 组患者更有可能接受胰岛素治疗(66% 对 46%),而且血糖低于范围的情况也较少(p < 0.001):结论:通过DEC管理EPTH可改善肾移植受者的血糖预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinics and Practice
Clinics and Practice MEDICINE, GENERAL & INTERNAL-
CiteScore
2.60
自引率
4.30%
发文量
91
审稿时长
10 weeks
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